Here are some of the questions that are most frequently posed about Hepatitis C. While answers to new questions submitted by subscribers are answered by members of the Hepatitis Week Medical Advisory Board, the FAQ data base draws heavily on responses developed by the Centers for Disease Control and Prevention, the National Institute of Health, and the Veterans Administration. If you have questions that are not answered in our FAQ Archive, feel free to submit them via email to editor@hepatitisweek.org.

What is hepatitis C?

Hepatitis C is a liver disease caused by infection with the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. ท Hepatitis makes your liver swell and stops it from working right. You need a healthy liver. The liver does many things to keep you alive. The liver fights infections and stops bleeding. It removes drugs and other poisons from your blood. The liver also stores energy for when you need it.

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What causes hepatitis C?

Hepatitis C is caused by a virus. ท A virus is a germ that causes sickness. (For example, the flu is caused by a virus.) People can pass viruses to each other. The virus that causes hepatitis C is called the hepatitis C virus (HCV).

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Is hepatitis C serious?

Hepatitis C is serious for some persons, but not for others. Most persons who get hepatitis C carry the HCV virus for the rest of their lives. Most of these persons have some liver damage but many do not feel sick from the disease. Some persons with liver damage due to hepatitis C may develop cirrhosis (scarring) of the liver and liver failure which may take many years to develop. Others have no long term effects.

Of every 100 persons infected with HCV about:

• 75 to 85 may develop long-term infection.
• 70 may develop chronic liver disease.
• 15 may develop cirrhosis over a period of 20 to 30 years.
• 3 may die from the consequences of long term infection (liver cancer or cirrhosis).
• Hepatitis C is a leading indication for liver transplants.

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How do you get hepatitis C?

Hepatitis C is spread primarily by contact with the blood of an infected person.

You could have received HCV from a blood transfusion or organ transplant before tests to identify donors with hepatitis C were available, or when they were less precise than they are now.

The discovery of HCV was reported in 1989, and the first blood test for HCV became available in May 1990, which identified most, but not all, donors infected with HCV. Improved blood tests were put into use in July 1992.

You could also get hepatitis C by:

• Sharing drug needles.
• Getting pricked with a needle that has infected blood on it (hospital workers can get hepatitis C this way).
• Being born to a mother with hepatitis C.
• Getting a tattoo or body piercing with unsterilized, dirty tools.
• Having sex with an infected person, especially if you or your partner has other sexually transmitted diseases.

You can NOT get hepatitis C by:

• Shaking hands with an infected person.
• Hugging an infected person.
• Kissing an infected person.
• Sitting next to an infected person.

Who is at risk?

About 4 million Americans are infected with HCV and most don't know it.

Your risk is higher if you:

• Ever injected street drugs, as the needles and/or other drug "works" used to prepare or inject the drug(s) may have had someone else's blood that contained HCV on them.
• Ever received blood, blood products, or solid organs from a donor whose blood contained HCV.
• Ever were on long-term kidney dialysis as you may have unknowingly shared supplies/equipment that had someone else's blood on them.
• Ever were a healthcare worker and had frequent contact with blood on the job, especially accidental needlesticks.
• Had a mother who had hepatitis C at the time she gave birth to you. During the birth her blood may have gotten into your body
• Ever had sex with a person infected with HCV.
• Lived with someone who was infected with HCV and shared items such as razors or toothbrushes that might have had his/her blood on them.

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How do you know if you have hepatitis C?

Many persons who have hepatitis C have no symptoms and feel well. The only way to tell if you have been infected with HCV is to have a blood test.

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What are symptoms of hepatitis C?

For some persons, the most common symptom is extreme tiredness. Others feel like they have the flu. So you might:

However, some people with hepatitis C feel like they have the flu. So, you might:

• Feel tired.
• Feel sick to your stomach.
• Have a fever.
• Not want to eat.
• Have stomach pain.
• Have diarrhea.

Some people have:

• Dark yellow urine.
• Light-colored stools.
• Yellowish eyes and skin.

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What are the tests for hepatitis C?

To check for hepatitis C, the doctor will test your blood. There are several blood tests that can be done to determine if you have been infected with HCV. Your doctor may order just one or a combination of these tests. They include:

• Anti-HCV (antibody to HCV).This test does not tell whether the infection is new (acute), chronic (long-term) or is no longer present.
• EIA (enzyme immunoassay) This test is usually done first. If positive, it should be confirmed.
• RIBA (recombinant immunoblot assay). A supplemental test used to confirm a positive EIA test.
• Qualitative tests to detect presence or absence of virus (HCV RNA).
• Generic polymerase chain reaction (PCR).
• Amplicor HCV™

A single positive PCR test indicates infection with HCV. A single negative test does not prove that a person is not infected. Virus may be present in the blood and just not found by PCR. Also, a person infected in the past who has recovered may have a negative test. When hepatitis C is suspected and PCR is negative, PCR should be repeated.

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Can you have a "false positive" anti-HCV test result?

Yes. A false positive test means the test looks as if it is positive, but it is really negative. This happens more often in persons who have a low risk for the disease for which they are being tested. For example, false positive anti-HCV tests happen more often in persons such as blood donors who are at low risk for hepatitis C. Therefore, it is important to confirm a positive anti-HCV test with a supplemental test as most false positive anti-HCV tests are reported as negative on supplemental testing.

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Can you have a "false negative" anti-HCV test result?

Yes. Persons with early infection may not as yet have developed antibody levels high enough for the test to measure. In addition, some persons may lack the (immune) response necessary for the test to work well. In these persons, research-based tests such as PCR may be considered.

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How long after exposure to HCV does it take to test positive for anti-HCV?

Anti-HCV can be found in 7 out of 10 persons when symptoms begin and in about 9 out of 10 persons within 3 months after symptoms begin. However, it is important to note that many persons who have hepatitis C have no symptoms.

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How long after exposure to HCV does it take to test positive with PCR?

It is possible to find HCV within 1 to 2 weeks after being infected with the virus.

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How is hepatitis C treated?

There are three treatments that have been approved by the Food and Drug Administration (FDA) for hepatitis C

• Interferon alone (called interferon monotherapy). Interferon is a protein that causes your body's immune system to attack infected liver cells, and to protect healthy liver cells from new infection. There are several brands of interferon made by different drug companies.
• Interferon combined with ribavirin (called combination therapy). Combination therapy is packaged as Rebetronฎ. Overall, this is much more effective than interferon monotherapy. If you have already had monotherapy treatment, and it didn't work, you may want to think about combination therapy, or experimental treatments. Note: Combination therapy is not right for all patients with hepatitis C. You must talk with your doctor about the risks and benefits of this therapy before you decide to try it.
• Long-acting interferon (called pegylated interferon therapy). This is a new kind of interferon. The FDA has recently approved it for patients who have never been treated before for hepatitis C.
• Surgery. Over time, hepatitis C may cause your liver to stop working. If that happens, you will need a new liver. The surgery is called a liver transplant. It involves taking out the old, damaged liver and putting in a healthy one from a donor

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How can I protect myself?

There is no vaccine to protect you against hepatitis C. But you can can protect yourself and others by:

• Not sharing drug needles with anyone.
• Wearing gloves if you have to touch anyone's blood.
• Not using an infected person's toothbrush, razor, or anything else that could have blood on it.
• Making sure, if you get a tattoo or body piercing, that it is done with clean tools.
• Using a condom if you have more than one sex partner.
• If you have hepatitis C, not giving your blood or plasma. The person who receives it could become infected with the virus.

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If you are pregnant and have hepatitis C, what is the risk of spreading HCV to your baby?

About 5 out of every 100 infants born to HCV infected women become infected. This occurs at the time of birth, and there is no treatment that can prevent this from happening.

Most infants infected with HCV at the time of birth have no symptoms and do well during childhood. More studies are needed to find out if these children will have problems from the infection as they grow older.

There are no licensed treatments or guidelines for the treatment of infants or children infected with HCV. Children with elevated ALT (liver enzyme) levels should be referred for evaluation to a specialist familiar with the management of children with HCV-related disease.

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Should a woman with hepatitis C be advised against breast-feeding?

No. There is no evidence that breast-feeding spreads HCV. HCV-positive mothers should consider abstaining from breast-feeding if their nipples are cracked or bleeding.

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When should babies born to mothers with hepatitis C be tested to see if they were infected at birth?

Children should not be tested for anti-HCV before 12 months of age as anti-HCV from the mother may last until this age. If testing is desired prior to 12 months of age, PCR could be performed at or after an infant's first well-child visit at age 1-2 months.

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